At the onset of an epileptic fit, which step should be taken first?

• A. Remove anything that may harm the casualty
• B. Remove any onlookers
• C. If no recovery within 5 minutes administer midazolam buccally and call 999
• D. Call 999 immediately

Answer: (B)

The first priority is safety. When a seizure starts, you act to protect the person from injury and reduce hazards around them.

The best initial step is to remove anything nearby that could cause harm. Clear away sharp objects, furniture, or anything they might hit, so their movements are less likely to cause injury. This directly lowers the risk of trauma during the convulsions.

After you’ve removed hazards, you can take other appropriate actions: avoid restraining the person, do not put anything in their mouth, and gently cushion the head and loosen tight clothing. Time the seizure and be prepared to call for help if it lasts longer than about five minutes or if there are complications. Administering a prescription medicine like midazolam should only occur under the specific protocol and by trained personnel. Removing onlookers can be helpful for privacy and space, but it doesn’t reduce immediate risk in the same direct way as removing hazards.